1. Women Survivors of Conflict in Liberia: Research and Training Helen Liebling Coventry & Warwick Universities hsx497@coventry.ac.uk

2. Context Conflict from 1989 ended with Comprehensive Peace Agreement in 2003 First woman Head of State, Hon. Ellen Johnson Sirleaf: November 2005 2006 Ministry of Gender spearheaded National Plan of Action on Gender-Based Violence First Country to implement UN Resolution 1325

3. Research Ministry of Gender and Development and Women Non-Government Organisations (Isis-WICCE, 2008) 643 participants; 80% women and 20% men Four Counties: Bong, Lofa, Maryland & Grand Kru Data collection and analysis:  Qualitative-Thematic analysis  Quantitative-Statistical Analysis

5. Findings Armed groups carried out widespread torture and abuse Destruction of infrastructure and communication High levels of brutality and displacement: serious effects on women and girl’s lives 43% of women became heads of households Women active campaigners for peace

6. Sexual Violence and Torture Extensive gendered physical, psychological and sexual torture Women used bodies for ‘safe passage’ Rape 73.9% of sexual violence and 62.5% suffered sexual torture Amongst highest sexual and domestic violence in world (IRIN, 2014) Under-reporting due to stigma and shame Sexual violence perpetrated against men (Hettonen et al. 2008) “Four NPFL soldiers raped me...they threatened me that if I refuse, they will kill me with my children. I accepted because I wanted to save my children and I knew they were serious...other women were raped, mutilated and then killed for me to survive together with my children” (Women from Maryland County)

7. Reproductive Health Effects Serious chronic reproductive and gynaecological health complications 68.5% at least one gynaecological complaint: more common in young women HIV/AIDS escalated Very high levels of stigma and under-reporting by women: “During the war in 1994 …I was searching for my children and I came across a group of five soldiers who raped me. In 2006 I fell very sick and...in 2007 I was diagnosed positive. It is only my sister who knows my status, even my husband does not know....I cannot tell my husband because he would abandon me with my four children” (Woman respondent from Pleebo, Maryland County)

8. Psychological Effects Population psychological problems and drug/alcohol addiction 80% suffered at least one form of psychological torture 42.8% significant psychological distress 12% alcohol addiction, 15% attempted suicide, 17.9% homicidal thoughts 69.1% reported this affected their ability to work Stigma and shame exacerbated psychological effects and trauma: “One of the women I have been counselling was raped by 7-10 soldiers every night for two weeks...She now feels useless and wanted to commit suicide. She could not tell her husband and the children...” (Male key informant in Monrovia)

9. Health Impact and Service Gap 50% no access to health care Lack of trained health workers and broken down infrastructure Unresolved trauma, likely to lead to cycle of violence and conflict (Liebling et al. 2008) “The degree of trauma and disorientation is so bad that our people are going to cemeteries and bursting the graves. They take out the bodies and throw them on the pavements. They live with their families in the graves and children are being produced in these graves....you see what the conflict has done.” (Key informant, Monrovia)

10. Liberia-Consultancy Training in Harper with 70 participants (EU-funded) Based on “Understanding & Treatment of Medical and Psychological problems of War Survivors of Violence and Torture”  Build capacity of community based health workers in identification and treatment of health problems of survivors  Illustrate importance of healing reproductive and psychological health problems so survivors can engage actively in rebuilding their lives and communities

11. Liberia-Consultancy Evaluation of medical and psychological treatment 1076 survivors; 685 women and 391 men assessed, received medical treatment and counselling Successful treatment of health problems resulted in decrease in stigma and increase in quality of life Policy documents disseminated Psychologist emphasising self-care Training participants sharing cultures

12. Summary Responses based on culturally sensitive/gendered understandings Sexual violence experienced as violation of body and rights: health and justice responses go hand in hand (Liebling & Baker, 2010) Health treatment reduces stigma and increases quality of life High levels of resilience amongst survivors Holistic services including economic empowerment Training -build resilience, gendered understanding, tackle gender inequalities, stigma and shame (Liebling, 2015) Focus groups for survivors and perpetrators Liberia’s economy depends on women: their needs and concerns must be at centre of post-conflict rebuilding

13. What are the Opportunities for Clinical Psychology? Promote holistic, empowering and gendered model Teaching and training Placement opportunities National/international research and policy development Improve cross-cultural knowledge: work with survivors Promote competencies in working with interpreters Engage local organisations and stakeholders to develop services Raise awareness e.g. Clinical Psychology Forum

14. ACKNOWLEDGEMENTS Stakeholders in Liberia Isis-WICCE, Uganda Faculty of Health and Life Sciences, Coventry University Women, men and children participants and key informants in Liberia Thank you for listening! Any Questions? Please contact : Helen.Liebling@coventry.ac.uk Isis-WICCE: http://www.isis.or.ug/